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� <br />e <br />Contractor Section: <br />�03 - �85-1 <br />Vendur Name I Business Name / UBI Nunfber <br />� Abso%s 8��. � 5 <br />State of Washington ntractor License Number: � <br />�� �3�Of� S7. �. <br />Vendor Mailing Address City State Zip <br />��6 - ���- ��q� A�dH�s-��a�� �a�a;�-�a� <br />Phone Email <br />I, the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the <br />installation at the above referenced property address. By agreeing to receive the rebate check <br />direclly, I agree to the following: <br />1. The Backwater Prevention Device rebate amount will be deducted from the final invoice <br />given to the property owner for the installation at the property address referenced above, if <br />the total cost of the installation is greater than the rebate. <br />2. I, the Vendor, am a Washington State licensed contractor. <br />3. The City oi Everett will send a Federal Form 1099 MISC to me, the Vendor, (or Backwater <br />Prevention Device rebale payments tolaling more than �600 per calendar year, and will <br />report the same payments to the Internal Revenue Service. <br />1 accept the payment of the Backwater Prevention Device rebate from the City of Everelt pending <br />approvai of the completed Backwater Prevention Device rebate package by the City of Everett <br />���-- 1' �''�''�� <br />Signature of Contractor Dale <br />J <br />